issue Infections The patient was a 45-year-old male who was in his usual state o
ID: 220381 • Letter: I
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issue Infections The patient was a 45-year-old male who was in his usual state of good health when he awoke at 3 a.m. with pain in the lateral aspect of his left calf.He looked at his calf and thought that the pain was due to an ingrown hair and went back to sleep. At 10 a.m., he expressed a small amount of pus from the ingrown hair. Over the next 8 hours, the patient developed an area of cellulitis on the lateral aspect of the calf of approximately 5 by 10 cm. At that time, a smal amount of pus was again expressed from the area of the ingrown hair. The next morning, the area of cellulitis extended from just below the knee to just above the ankle. The patient visited his physician. His vital signs at that visit, includ- ing pulse, respirations, blood pressure, and temperature, were all within normal limits. Physical exam was significant for an area of cellulitis as described that was red and warm to the touch but with no area of obvious fluctuance. No lym- phadenopathy was observed. The central area of the cellulitis, near the area that the patient described as where the ingrown hair had been, was punctured three times with a 20-gauge needle but no pus was drained. The patient was referred to the surgery service. The surgeons examined the patient and said they would follow him. The patient was given 2 g of ceftriaxone intramuscularly and begun on oral cephalexin. The patient returned to the surgical clinic 48 hours later with an obvious area of fluctuance in the center of the area of cellulitis. Over the preceding 48 hours, the patient reported low-grade fevers. Approximately 1 ml of pus was aspirated and was sent for Gram stain and culture (Fig. 1 and 2). When pus was aspirated from the lesion, the surgeon decided to excise and drain the lesion Fig. 3) 1. Based on Gram stain and culture, what is the organism most likely causing this patient's infection? How do you think he became infected with this organism? gure 1 Fiqure 2Explanation / Answer
1) Gram stain indicates that the organism is Gram positive and cellulitis is mostly caused by Staphylococcus aureus. As the ingrown hair was punctured three times through a needle, lead to the entrance of bacteria entered through this site.
2) Incision and drainage along with antibiotic therapy is prescribed when the cellulitis leads to skin necrosis. Incision and drainage removes the toxic material and decompress the tissues, allowingcriculation of antibiotics in the blood and increased oxygenation of the infected area.
3) Along with skin infection, Staphylococcus can cause serious infections such as bloodstream infections, pneumonia, or bone and joint infections.
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